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Introduction. The choice of surgical treatment with kidney stone disease directly depends on the size of the kidney stones. According to clinical guidelines for the treatment of urolithiasis in children, the size of a kidney stone in adult patients is used to determine tactics. Normally, the longitudinal size of the kidney of a child, for example, 1-3 years old, is 2 times smaller than that of an adult, and the width of the child's ureter is 37% less than the width of the adult's ureter. But anatomical and age differences in children (infant, preschool, school and adolescence) are not taken into account. Existing prognostic nomograms for urolithiasis (Dogan, Onal, CMUN, SKS, Guy's Stone Score, S.T.O.N.E, and CROES) that are validated for use in children also do not take this into account. Thus, the size of a kidney stone, as a criterion for choosing an effective and safe method of surgical treatment, needs to be clarified. The purpose of the study: to define the concept of a large kidney stone in children of different age groups. Materials and methods. We analyzed clinical guidelines, domestic and foreign publications on the use of «kidney stone size» in children of different ages and the principles of substantiation of the term large kidney stone. 320 histories of percutaneous nephrolitholopaxy (PNL) from 2008-2019 were retrospectively and perspectively analyzed. aged from 1 to 17 years, the average age of patients is 6.6 years. The average calculus size was 26 (15-58) mm. Number of patients in different age groups: toddlers 1-3 y/o – 73, pre-school child 3-5 y/o. – 71, school child 6-12 y/o – 79, adoloscents 12-18 y/o – 97. By type of calculus: single –125 (39.1%), multiple – 68 (21.3%), K1, K2 – 46 (14.3%), K3, K4 – 81 (25.3%). The weight of the patients ranged from 8–94 kg, the average weight was 21 kg, the height was from 73–180 cm, and the average height was 120 cm. The length of the child's kidney depends on his age, the formula for calculating the length of the kidney (cm) = 6.79 + 0.22 x age (g)) Result. KSS-CDA: Kidney stone size in children different ages was proposed: KSS-CDA = (stone size (mm)/the kidney length (mm))*100%. KSS-CDA makes the interpretation of the size of kidney stones in children from different age groups objective. The definition of "Large" kidney stone is used if the size of the stone is 20% or more of the longitudinal size of the kidney in children. For example, a child is 1 year 7 months old, the stone is 15 mm, the length of the kidney is 69 mm. The SSEF is 21.74%, this kidney stone can be described as «large». The «medium» stone size is 10-20% (6-14 mm), small

Commentary on the article Surov R.V., Kagantsov I.M., Shmyrov O.S., Sizonov V.V., Volkova A.A., Zadykyan R.S., Kulaev A.V., Lasishvili M.N., Velskaya Yu.I. Comparative analysis of the use of one-stage and two-stage urethroplasty in the treatment of children with proximal forms of hypospadias. Flap or graft?, published in the Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(4):437444. (In Russ.) DOI: https://doi.org/10.17816/psaic968

Objective To evaluate an outcome of endoscopic correction of vesicoureteral reflux (VUR) using Vantris (Promedon, Cordoba, Argentina) in terms of its effectiveness and morbidity in a multicenter study. Materials and Methods From 2009 to 2013, 611 patients (210 boys and 401 girls) with a mean age of 3.56 years (range, 1 month-18 years) were treated at 7 centers worldwide endoscopically with Vantris injection. VUR was unilateral in 413 and bilateral in 198 patients comprising 809 renal refluxing units (RRUs). Of these, primary VUR was present in 674 RRUs (83.3%) and 135 (16.7%) were complex cases. Reflux was grades I-V in 24 (2.96%), 123 (15.2%), 451 (55.8%), 158 (19.5%), and 53 (6.6%) RRUs respectively. The follow-up continued from 6 to 54 months. Results Reflux resolved in 759 RRUs (93.8%) after first Vantris injection, in 26 (3.1%) after second, and in 6 (0.7%) after third injection, respectively. VUR improved to grade I after 1 or 2 injections in 5 ureters (0.6%), which needed no further treatment. Thirteen ureters (1.6%) failed endoscopic correction and required ureteral reimplantation. Vesicoureteral junction obstruction requiring ureteral reimplantation developed in 6 ureters (0.7%) and in 4 (0.5%) required stent insertion. Twenty-three patients (3.8%) suffered afebrile urinary tract infection. Seven (1.2%) developed febrile urinary tract infection. None of the studied patients demonstrated VUR recurrence on voiding cystourethrography. Conclusion The results of this multicenter survey confirm that endoscopic subureteral Vantris injection is a simple, safe, and effective outpatient procedure for treating all grades of VUR.

Purpose Specialists debate whether it is reasonable or not to preserve a bladder exstrophy plate with a minimum size of less than 25 – 30 mm. Many urologists recommend that cystectomy be performed and the ureters be diverted from the bladder to an isolated segment of bowel. Is it possible to preserve bladder function in patients with minimum bladder sizes? Material and Methods Over a period of 1996-2008, 60 children from two days to eight months of age underwent surgical repair of bladder exstrophy. Group 1 included 42 (60%) children with a satisfactory size (>30 mm) of bladder plate, and group 2 included 18 (30%) with a small size ( Results The outcomes of primary closure were analyzed with regard to detrusor volume and dry periods. In the children under one year of age, the volume of the bladder was 30-70 ml in group 1 and 20-40 mm in group 2. However, 12 children from group 2 voided small portions of urine with dry periods of up to 10-15 min. At the age 1-3 years old, the children from group 2, with small bladder plates, underwent Cantwell-Ransley repair combined with grafting dorsal surface of corporeal bodies with endoscopic VUR correction (STING) as the second step of treatment. Finally, the bladder volume in the children from group 2 increased up to 50-60 ml, with dry periods of up to 30-40 min. At the next step of treatment, six patients from group 2 underwent uretrocystoneoctomy and bladder neck plasty. As a result, in the children of 1-3 years old, with small bladder plates, the bladder volume was 70-120 ml and dry periods were 40-70 min. Conclusions Our findings evidence that, even with small bladder plates, it is possible to achieve satisfactory outcomes of treatment of bladder exstrophy